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2015 ; 94
(40
): e1459
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Safety and Efficacy of the Moderate Sedation During Flexible Bronchoscopic
Procedure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
#MMPMID26447999
Hong KS
; Choi EY
; Park DA
; Park J
Medicine (Baltimore)
2015[Oct]; 94
(40
): e1459
PMID26447999
show ga
Moderate sedatives have been increasingly used to improve patient comfort during
flexible bronchoscopy (FB). However, routine use of moderate sedation during FB
is controversial because its efficacy and safety are not well established. This
study aims to evaluate the efficacy and safety of moderate sedation during FB. A
search was made of Medline, EMBASE, and the Cochrane Library to May 2014.
Randomized controlled trials (RCTs) and quasi-RCTs were included. The main
analysis was designed to examine the efficacy of moderate sedation during FB in
sedation than no-sedation. The willingness to repeat FB was significantly more in
sedation than no-sedation (odds ratio [OR] 2.30; 95% confidence interval [CI]
1.11-4.73; P = 0.02; I2 = 22.5). The duration of FB was shorter in sedation group
than no-sedation group (standardized mean difference [SMD] -0.21; 95% CI -0.38 to
-0.03; P = 0.02; I2 = 78.3%). Event of hypoxia was not significantly different
between sedation and no-sedation groups (OR 0.86; 95% CI 0.42-1.73; P = 0.67; I2
= 0%). The SpO2 during procedure was not different between sedation and
no-sedation groups (SMD -0.14; 95% CI -0.37 to 0.08; P = 0.21; I2 = 49.9%).
However, in subgroup analysis without supplemental oxygen, the SpO2 was
significantly lower in sedation than no-sedation group (SMD -0.45; 95% CI -0.78
to -0.11; P = 0.01; I2 = 0.0%). According to this meta-analysis, moderate
sedation in FB would be useful in patients who will require repeated
bronchoscopies as well as safe in respiratory depression. To our knowledge,
although the various sedative drugs are already used in the real field, this
analysis was the first attempt to quantify objective results. We anticipate more
definite and studies designed to elucidate standardized outcomes for moderate
sedation in FB.